Accurate Diagnosis Is Important
A thorough medical examination can usually identify the specific dementia diagnosis. Knowing the diagnosis can help family members better understand and cope with their situation. For example, if a person with frontal-lobe dementia makes hurtful remarks, a well-prepared family member may better take the remarks in stride. If a person with Lewy Body dementia is talking to little people in the room, a caregiver who understands that this is common will know not to overreact.
Aricept And Herbs And Supplements
There arent any herbs or supplements that have been specifically reported to interact with Aricept. But St. Johns wort, an herbal remedy thought to ease depression, may interact with Aricept. This herb could affect how well the drug works.
Before using any herbs or supplements while taking Aricept, talk with your doctor or pharmacist.
Doctors Not Surprised By 11 Patient Deaths In Dementia Drug Trial
What was surprising, they said, was the lack of deaths in the placebo group.
The people were all enrolled in a study investigating whether Aricept, currently approved for use for patients with Alzheimer’s disease, also might help people suffering from vascular dementia, a brain disorder that lessens a person’s ability to think and perform daily activities. It is caused by damage to the blood vessels bringing oxygen-rich blood to the brain.
In the trial, 648 patients received Aricept for 24 weeks while 326 patients received an inactive medication, or placebo. Overall, 1.7 percent of the patients taking Aricept died.
That may seem unusually high, but several doctors said they were not surprised by the number of deaths in the patients taking Aricept.
Patients with vascular dementia are often older and have other diseases that damage blood vessels, such as diabetes, high blood pressure and heart disease. This means patients with vascular dementia have a higher risk of death than healthy patients of the same age.
“The death rate in this study for the group does not differ greatly from that in previous trials. The unexpected difference is in the placebo group,” said Dr. Myron F. Weiner, a psychiatry and neurology professor at the University of Texas Southwestern Medical School in Dallas. “I can’t explain why the placebo group did so well.”
Drug is Safe, Doctors Attest
Dr. Rachelle Smith Doody agreed.
But what does this study mean for patients with both forms of dementia?
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Vascular Dementia Where Are The Drugs
With each heartbeat, blood vessels deliver around 15% of your blood up into your brain. This energy-hungry organ can only keep going thanks to the constant supply of nutrients and oxygen that are carried to it in the blood.
Hundreds of miles of arteries, veins and capillaries circulate blood around every inch of the brain. If this intricate network of blood vessels becomes damaged, or something interrupts the flow of blood, brain cells can stop functioning properly and die. This is what underlies vascular dementia, the second most common cause of dementia and a condition that affects around 150,000 people in the UK.
While there are no treatments that can stop the spread of a disease like Alzheimers through the brain, there are at least some drugs that can help with the symptoms. For vascular dementia, there are no such medications, and in a session at last months Alzheimers Association International Conference, researchers posed the critical question Where are the drugs?
How Well Do Cholinesterase Inhibitors Work
This is a topic that has been intensively studied and somewhat debated. Of note, most major studies of cholinesterase inhibitors are industry-funded only the AD2000 trial was not industry-funded.
Overall, in mild to moderate Alzheimers disease, the average benefit seems to be a small improvement in cognition and ability to manage activities of daily living. The effect has been sometimes compared to a few months delay in progression of symptoms.
A 2008 review of the scientific evidence concluded that the effect of these drugs is statistically significant but clinically marginal.
But theres a catch to consider: studies also suggest that although a fair number of people seem to experience no benefit at all, up to 20% may show greater than usual response. So there seems to be some individual variability in how these drugs work for people.
It may also depend on the type of dementia a person has, with some studies suggesting cholinesterase inhibitors have an effect in many people with Parkinsons disease dementia, and perhaps also dementia with Lewy bodies.
To date, we have not developed any good ways to tell ahead of time who will respond to these drugs.
So its important to follow a persons cognitive symptoms, and side-effects, once they start taking a cholinesterase inhibitor. If it doesnt seem to be helping, its reasonable to consider stopping the medication after a few months.
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Will Aricept Cause Worsened Dementia
Aricept is used to treat dementia thats caused by Alzheimers disease. Currently, there is no cure for Alzheimers disease. But Aricept may help slow progression of dementia symptoms in some people.
Aricept doesnt work the same for everyone with Alzheimers disease. Some peoples cognitive function seems to improve for a while with Aricept treatment. They may also be able to perform daily tasks better, such as making meals or doing laundry. Other people seem to stay the same for a while, but Aricept may help to slow their disease progression.
Aricept may be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what its been approved for by the FDA.
Some studies have found that Aricept can make a certain form of dementia worse. Specifically, Aricept may worsen dementia caused by frontotemporal lobar degeneration . According to the National Institute on Aging, FTLD is the leading cause of dementia in people younger than age 60.
If you have questions about whether Aricept may help your condition, talk with your doctor.
Fca Fact And Tip Sheets
A listing of all FCA fact and tip sheets is available online at www.caregiver.org/fact-sheets.
The National Stroke Association provides education, information and referral, and research on stroke for families, health care professionals, and others interested in or affected by stroke.
American Stroke AssociationThe American Stroke Association offers information and sponsors programs and support groups throughout the nation for stroke survivors and family members.
American Heart AssociationThe American Heart Association provides public health education to community members, healthcare professionals, and to lawmakers and policymakers.
National Institute of Neurological Disorders and Strokewww.ninds.nih.govThe National Institute of Neurological Disorders and Stroke supports and performs basic, translational, and clinical neuroscience research through grants-in-aid, contracts, scientific meetings, and through research in its own laboratories, and clinics.
101 Montgomery Street | Suite 2150 | San Francisco, CA 94104
800.445.8106 toll-free | 415.434.3388 local
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How To Slow Down Dementia: Treatment Options Therapies And Supportive Care
Many people are confused about whether Alzheimers disease and other forms of dementia are treatable. The short answer?
There is currently no cure for dementia, says Ardeshir Hashmi, MD, section chief of the Center for Geriatric Medicine at Cleveland Clinic.
But, he says, a variety of treatment options can help manage symptoms, improve quality of life, and slow the progression of disease. Read on for Hashmis roundup of current dementia treatment options, along with his main takeaways for caregivers.
Types Of Vascular Dementia
Vascular dementia can be divided into two types: post-stroke dementia and multi-infarct dementia .
POST-STROKE DEMENTIASymptoms are most obvious when they arise suddenly following a stroke, resulting in the blood supply to the brain being suddenly interrupted due to a blocked artery. This disruption can lead to damage or death of brain tissue. Not all stroke victims develop dementia it is estimated that approximately 20% of stroke patients develop post-stroke dementia within six months. Post-stroke dementia can result in physical symptoms and/or problems with vision or speech. Symptoms depend on what area and how much of the brain is affected.
MULTI-INFARCT DEMENTIAThis type of dementia results from a series of mini-strokes in vessels located deep within the brain . These mini-strokes may not lead to any sudden obvious onset of symptoms however, even these âsilent brain infarctionsâ still increase the risk of dementia, a result of disease of the brainâs blood vessels. Over time, the effects of this damage can result in dementia. Progression is referred to as âstep-wiseâ because symptoms worsen after any additional mini-strokes and then remain the same for a time. Symptoms that may develop include changes in reasoning and other thinking skills such as memory, as well as mood and behavior problems, including depression and apathy.
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What To Do In Case Of Overdose
If you think youve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.
When you get Aricept from the pharmacy, the pharmacist will add an expiration date to the label on the bottle or packaging. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee that the medication is effective during this time. The of the Food and Drug Administration is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.
Donepezil And Memantine Prescribed Together
In people with moderate to severe Alzheimers or other types of dementia, donepezil and memantine have been known to be prescribed in combination, or together. The brand name for this prescription combination is Namzaric. Both these drugs act upon different chemicals in the brain, and their combination is believed to have an added benefit for some individuals.
While donepezil increases the levels of acetylcholine in the brain, therefore increasing communication between brain cells, memantine lowers the level of glutamate, which at high levels can damage and kill brain cells. Therefore, these drugs work to alleviate cognitive symptoms such as problems with memory and confusion or disorientation, but they simply do so in different ways.
Another additional benefit seen with this combination therapy of donepezil and memantine is an improvement in behavioral symptoms such as agitation. Lastly, patients experiencing uncomfortable side effects like diarrhea due to donepezil can sometimes experience some relief due to memantines side effect of constipation.
Closer Look: Bobs Benefit from Combination Therapy
Alfred became the primary caregiver for his uncle Bob after he was diagnosed with Alzheimers disease about 5 years earlier. Alfreds father and Bob were twins, and Alfred grew up in very close proximity to his uncle who always treated him like a son. Bob in time progressed into the more moderate stages of the disease and has been on donepezil for about 12 months.
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Donepezil Effective In Vascular Dementia
“In these groundbreaking studies — the largest clinical trials to study vascular dementia — Aricept has been shown to improve cognitive function in patients with vascular dementia,” lead author Raymond Pratt, MD, from Eisai Inc. in Teaneck, New Jersey, says in a news release. “These results are extremely important because currently there are no approved treatments for this condition.”
In a 24-week double-blind, placebo-controlled, parallel-group trial, the Donepezil 307 Study Group randomized 603 patients with probable or possible vascular dementia according to NINDS-AIREN criteria to treatment with donepezil 5 mg/day for the first 28 days followed by 10 mg daily, donepezil 5 mg daily throughout, or placebo.
At week 24, both donepezil-treated groups showed significant improvements in cognitive function compared with placebo on the cognitive component of the ADAS, the MMSE, and the CIBIC-plus. Functional deterioration was significantly slowed in donepezil-treated patients compared with placebo-treated patients.
Despite comorbid cardiovascular disease in 89% of subjects, donepezil was well tolerated. Withdrawal rates due to adverse events were 11.1% for placebo and for donepezil 5 mg/day, and 21.8% for donepezil 10 mg/day.
AAN 54th Annual Meeting: Abstracts #P05.115 and S20.005. April 17, 2002.
Reviewed by Gary D. Vogin, MD
Mechanisms Of Neurodegeneration And The Role Of Glutamate Receptors
Vascular dementia arises as a consequence of ischemic insults such as hemorrhage and hypoperfusion that trigger neurodegeneration by depriving nerve cells of oxygen and glucose . Oxygen and glucose deprivation results in depletion of nerve cell energy supplies, leading to membrane depolarization, followed by an excessive release of glutamate, which, in turn, over activates the N-methyl-D-aspartate receptor/channel complex . Over activation of neuronal NMDA receptors allows influx of toxic levels of Ca2+ into nerve cells , which enables activation of various intracellular calcium-dependent enzymes . The mechanism of glutamate toxicity and its various components are potential therapeutic targets, and merit a more detailed discussion here.
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Dietary Supplements For Dementia
Many dietary supplements have been studied for dementia treatment, including ginkgo biloba, vitamin B, and omega-3 fatty acids. However, results havent shown significant benefits. Talk to a doctor before giving your loved one with dementia any dietary supplements or herbal medicine. This will help prevent side effects and interactions with other drugs.
How Aricept Works Mechanism Of Action
Donepezil is known as an acetylcholinesterase inhibitor, or cholinesterase inhibitor, meaning its main mechanism of action is to prevent the breakdown of a neurotransmitter called acetylcholine. Neurotransmitters are chemical messengers that are essential to communication between brain cells . More specifically, Aricept inhibits the enzyme acetylcholinesterase , which initiates the breakdown process of acetylcholine in the brain.
It has been found that individuals with Alzheimers Disease and certain other dementias have lower levels of acetylcholine. This contributes to their cognitive symptoms, including problems with memory, learning, and confusion. Donepezil stops acetylcholinesterase from breaking down these chemical messengers, and subsequently keeps acetylcholine levels high within the brain, thus improving communication between brain cells, and alleviating memory loss and other symptoms.
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Do Any Vitamins Help Treat Dementia
Vitamin E which works as an anti-oxidant in the body has been studied for the treatment of Alzheimers, and may be beneficial.
In 2014, a large study of patients with moderate-to-severe Alzheimers disease found that daily treatment with 2000 IU/day of Vitamin E resulted in less functional decline than treatment with placebo, memantine, or a combination of memantine and vitamin E.
Of note, since the study was conducted in the VA health system, most participants were men. And again, the benefit seen was modest.
It is not clear that vitamin E helps for milder Alzheimers, or mild cognitive impairment. Always talk to a doctor before trying vitamin E for brain health, as vitamin E can increase bleeding risk in some people.
No other vitamins have been shown to slow cognitive decline in Alzheimers or other dementias. In particular, although low vitamin D levels have been associated with a risk of developing dementia, no clinical research has shown that treatment with vitamin D helps people maintain cognitive function.
A study of vitamin B supplementation in the treatment of people with mild to moderate Alzheimers disease did not show any benefit. Note that participants in this study had normal vitamin B12 levels at baseline the very common problem of vitamin B12 deficiency in older adults can cause or worsen cognitive problems.
Is It Common To Take More Than One Medication For Dementia At The Same Time
Its quite common for patients to be prescribed a cholinesterase inhibitor plus memantine.
This combination therapy has been studied in people with moderate-to-severe Alzheimers, and some research suggests a small benefit compared to treatment with just one medication. However, the benefit again appears to be modest at best.
A study of combination therapy in people with mild-to-moderate Alzheimers did not show benefit. There is no good research evidence indicating that combination therapy is beneficial in mild Alzheimers.
There is no reason to take more than one cholinesterase inhibitor at the same time.
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Effect Of Aricept On Alzheimers Lewy Body Dementia And Vascular Dementia
Aricept has undergone multiple drug studies in different countries, including Sweden and Japan, that demonstrated its efficacy in treating Alzheimers disease. There continue to be studies on donepezil, including its use to treat other types of dementia and research on different delivery systems of the drug.
For example, researchers in Japan have studied donepezil in the form of a transdermal patch, but were declined FDA approval in 2011. Today, there are clinical trials being conducted on the efficacy of donepezil in treating Lewy Body Dementia. Additional research is also being conducted on the effectiveness of donepezil in treating the cognitive symptoms of Vascular Dementia. While many of these studies are ongoing or have produced mixed results, the continued effort to find other uses for Aricept may eventually deem it as an effective treatment for various other types of dementia. Certain dementias, like Frontotemporal Dementia, do not result in depleted acetylcholine levels. Donepezils mechanism of action in raising acetylcholine levels thus makes it inappropriate for alleviating cognitive symptoms in these types of dementia. Research into the causes and molecular etiology of different Types of Dementia is necessary to determine appropriate Dementia Treatment.
Is There Treatment Available
While no treatment can reverse damage that has already been done, treatment to prevent additional strokes is very important. To prevent strokes, medicines to control high blood pressure, high cholesterol, heart disease and diabetes can be prescribed. A healthy diet, exercise and avoidance of smoking and excessive alcohol also lessen the risk of further strokes. Sometimes aspirin or other drugs are prescribed to prevent clots from forming in the small blood vessels.
Drugs can also be prescribed to relieve restlessness or depression or to help the person with dementia to sleep better. In some cases surgery known as carotid endarterectomy may be recommended to remove blockage in the carotid artery, the main blood vessel to the brain. Recent research suggests that cholinesterase inhibitor medications such as Donepezil and Galantamine , which are helpful for some people with Alzheimer’s disease, may also be of some benefit to some people with Vascular dementia. However, the evidence is not yet as clear or compelling as that for the use of these medications with Alzheimer’s disease.
Support is available for the person with Vascular dementia, their families and carers. This support can make a positive difference to managing the condition. Dementia Australia provides support, information, education and counselling for people affected by dementia. Up-to-date information about drug treatments is also available from Dementia Australia.
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